AJM onlineClinical communication to the EditorMultiple Cystic Metastases in the Brain from Adenocarcinoma of the Lung
Section snippets
Case Report
A 66-year-old woman presented with progressive sleepiness and disorientation that had developed for 3 months. Two years prior, an inoperable non-small-cell lung cancer with intrapulmonal metastases was diagnosed, irradiated repeatedly, and treated palliatively with chemotherapy. The neurological examination showed speech impairment, motor apraxia, and slightly exaggerated muscle tendon reflexes on the left side, but no other focal signs. Lymphocytes were diminished, alkaline phosphatase and
Discussion
Brain lesions in patients with known malignancies are suspicious for metastases. Usually, these present as well-circumscribed, densely enhancing masses with surrounding vasogenic edema. In contrast, cystic lesions are unusual and can, therefore, be misdiagnosed as brain abscesses, primary cerebral tumors, or parasitic infections, especially in patients without a history of malignancy.1, 2, 3
Otherwise, nonmetastatic cerebral cystic lesions can be mistaken for metastases in patients with known
Conclusion
Our case demonstrates an unusual pattern of cerebral metastases in a patient with bronchial carcinoma. This constellation should be considered in the differential diagnosis of cerebral cystic lesions, the exact nature of which might be difficult to assess without biopsy.
References (8)
- et al.
Asymptomatic neurocysticercosis in a patient with AIDS and criptococcal meningitis
Am J Med
(1995) Cases from the Osler Medical Service at Johns Hopkins University
Am J Med
(2002)- et al.
Multiple brain metastases from malignant thymoma
J Clin Neurosci
(2007) - et al.
Intraoperative cystodiagnosis of metastatic brain tumors confused clinically with brain abscessA report of three cases
Acta Cytol
(2000)
Cited by (9)
Clinical presentation of neurocysticercosis-related epilepsy
2017, Epilepsy and BehaviorCitation Excerpt :A second case of absolute diagnosis has been proposed when a bright 2- to 3-mm nodule is seen inside the cyst as it might represent the scolex (the parasite's “head”) [79] (see Fig. 2). A few etiologies may mimic a nodule inside a cyst such as debris in cystic metastatic or primary brain tumors, or a few other neuroinfectious diseases [79–81]; although, additional characteristics of the cyst, apart from other clinical features, should address to the most likely diagnosis. Viable NCC cysts are usually less than 20 mm in diameter, well-rounded and with fluid-filled content as hyperintense as CSF in T2-weighted MRI.
Revised set of diagnostic criteria for neurocysticercosis (in reply to Garg and Malhotra)
2017, Journal of the Neurological SciencesCystic brain metastases in ALK-rearranged non-small cell lung cancer
2018, ecancermedicalscienceAdenocarcinoma of the lung presenting with atypical cystic brain lesions
2014, BMJ Case Reports
Funding: None.
Conflict of Interest: None.
Authorship: All authors had access to the data.